Coronavirus Disease 2019 (COVID-19) - WHO

Coronavirus disease 2019 (COVID-19)Situation Report – 94Data as received by WHO from national authorities by 10:00 CEST, 23 April 2020HIGHLIGHTSSITUATION IN NUMBERStotal (new cases in last 24 hours) The Global Outbreak Alert and Response Network (GOARN) has launched aGOARN COVID-19 Knowledge hub. The hub is designed as a central repository ofquality public health information, guidance, tools and webinars which can beaccessed freely at any point.WHO Director-General Dr. Tedros, in his regular media briefing yesterday,cautioned that “we have a long way to go. This virus will be with us for a longtime”. He added that “the world cannot go back to the way things were. Theremust be a “new normal” – a world that is healthier, safer and better prepared”.His speech can be found here.WHO has published guidance ‘Addressing Human Rights as Key to the COVID-19Response’. The guidance document highlights the importance of integrating ahuman rights-based approach into the COVID-19 response and highlights keyconsiderations in relation to addressing stigma and discrimination, preventionof violence against women, support for vulnerable populations, quarantine andrestrictive measures, and shortages of supplies and equipment.All available evidence for COVID-19 suggests that SARS-CoV-2 has a zoonoticsource. Many researchers have been able to look at the genomic features ofSARS-CoV-2 and have found that evidence does not support that SARS-CoV-2 isa laboratory construct. A constructed virus would show a mix of known elementswithin genomic sequences – this is not the case. For more details, please see‘subject in focus’.Globally2 544 792 confirmed (73 657)175 694 deaths (6689)European Region1 251 458 confirmed (31 972)113 336 deaths (3384)Region of the Americas957 402 confirmed (32 111)47 812 deaths (3038)Eastern Mediterranean Region144 450 confirmed (5101)6469 deaths (143)Western Pacific Region137 902 confirmed (1632)5818 deaths (25)South-East Asia Region36 039 confirmed (2127)1498 deaths (71)African Region16 829 confirmed (714)748 deaths (28)WHO RISK ASSESSMENTGlobal LevelFigure 1. Countries, territories or areas with reported confirmed cases of COVID-19, 23 April 2020Very High

SUBJECT IN FOCUS: Origin of the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2), the virus causing COVID-19The first human cases of COVID-19, the disease caused by the novel coronavirus causing COVID-19, subsequentlynamed SARS-CoV-2 were first reported by officials in Wuhan City, China, in December 2019. Retrospectiveinvestigations by Chinese authorities have identified human cases with onset of symptoms in early December 2019.While some of the earliest known cases had a link to a wholesale food market in Wuhan, some did not. Many of theinitial patients were either stall owners, market employees, or regular visitors to this market. Environmental samplestaken from this market in December 2019 tested positive for SARS-CoV-2, further suggesting that the market inWuhan City was the source of this outbreak or played a role in the initial amplification of the outbreak. The marketwas closed on 1 January 2020.SARS-CoV-2 was identified in early January and its genetic sequence shared publicly on 11-12 January. The fullgenetic sequence of SARS-CoV-2 from the early human cases and the sequences of many other virus isolated fromhuman cases from China and all over the world since then show that SARS-CoV-2 has an ecological origin in batpopulations. All available evidence to date suggests that the virus has a natural animal origin and is not amanipulated or constructed virus. Many researchers have been able to look at the genomic features of SARS-CoV-2and have found that evidence does not support that SARS-CoV-2 is a laboratory construct. If it were a constructedvirus, its genomic sequence would show a mix of known elements. This is not the case.Another coronavirus, SARS-CoV-1, the cause of the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, wasalso closely related to other coronaviruses isolated from bats. These close genetic relations of SARS-CoV-1, SARSCoV-2 and other coronaviruses, suggest that they all have their ecological origin in bat populations. Many of thesecoronaviruses can also infect several animal species. For example, SARS-CoV-1 infected civet cats and then humans,while the virus causing the Middle East Respiratory Syndrome (MERS-CoV) is found in dromedary camels, and hascontinued to infect humans since 2012.All available evidence for COVID-19 suggests that SARS-CoV-2 has a zoonotic source. Since there is usually limitedclose contact between humans and bats, it is more likely that transmission of the virus to humans happened throughanother animal species, one that is more likely to be handled by humans. This intermediate animal host or zoonoticsource could be a domestic animal, a wild animal, or a domesticated wild animal and, as of yet, has not beenidentified.All the published genetic sequences of SARS-CoV-2 isolated from human cases are very similar. This suggests that thestart of the outbreak resulted from a single point introduction in the human population around the time that thevirus was first reported in humans in Wuhan, China in December 2019.A number of investigations to better understand the source of the outbreak in China are currently underway orplanned, including investigations of human cases with symptom onset in and around Wuhan in late 2019,environmental sampling from markets and farms in areas where the first human cases were identified, and detailedrecords on the source and type of wildlife species and farmed animals sold in these markets.Results from these studies are essential to preventing further zoonotic introductions of SARS-CoV-2 into the humanpopulation. WHO continues to collaborate with animal health and human health experts, Member States, and otherpartners to identify gaps and research priorities for the control of COVID-19, including the eventual identification ofthe source of the virus in China.

SURVEILLANCETable 1. Countries, territories or areas with reported laboratory-confirmed COVID-19 cases and deaths. Data as of23 April 2020*Reporting alconfirmednew cation§Days since lastreported 2190120000Clusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesSporadic casesSporadic casesSporadic cases000000016311019188001000000Sporadic casesSporadic casesSporadic cases10201335718000500000Clusters of casesSporadic casesSporadic cases11120Western Pacific RegionChinaJapanRepublic of KoreaSingaporePhilippinesAustraliaMalaysiaNew ZealandViet NamBrunei DarussalamCambodiaMongoliaLao People'sDemocratic RepublicFijiPapua New GuineaTerritories**GuamFrench PolynesiaNew CaledoniaNorthern MarianaIslands(Commonwealth ofthe)European 7327337025085437Germany14804623525094215The United urkeyRussian ionCommunitytransmissionClusters of casesCommunitytransmission0000000

057818713CzechiaSerbiaFinlandLuxembourgRepublic of AzerbaijanArmeniaLithuaniaBosnia 744202438011000136727522SloveniaNorth iaKyrgyzstan724634631101937278011San missionPendingPendingPendingPendingPendingClusters of casesPendingPendingCommunitytransmissionClusters of casesPendingClusters of casesClusters of sionClusters of casesClusters of casesPendingClusters of casesPendingCommunitytransmissionClusters of 000000000000000000000000001000

GeorgiaMontenegroLiechtensteinMonacoHoly oIsle of ManJersey6303072552605181014000GuernseyFaroe IslandsGibraltarGreenlandSouth-East Asia ndonesia7418Bangladesh3772Thailand2839Sri utan7Eastern Mediterranean RegionIran (Islamic Republicof)85996Saudi Arabia12772Pakistan10513United Arab 260CommunitytransmissionClusters of casesPendingSporadic casesSporadic ransmissionPendingClusters of casesPendingClusters of casesCommunitytransmissionPendingPendingClusters of casesClusters of casesClusters of casesSporadic casesClusters of casesSporadic casesCommunitytransmissionClusters of casesClusters of casesPendingPendingClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesCommunitytransmissionClusters of casesClusters of casesSporadic casesSporadic casesClusters of cases004920100351700000000200000000000000010100

s of can 721967ArgentinaCubaCosta RicaBolivia (PlurinationalState of)UruguayHondurasGuatemalaVenezuela (BolivarianRepublic of)El nCommunitytransmissionClusters of casesClusters of cases609543510316118162237124683200Clusters of casesClusters of casesClusters of casesClusters of cases0000288237233312101076000000ParaguayTrinidad and TobagoBarbadosGuyanaBahamasHaitiAntigua and BarbudaBelizeDominicaSaint Kitts and NevisSaint 985794320000100001000000Clusters of casesClusters of casesClusters of casesCommunitytransmissionSporadic casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesSporadic casesClusters of casesSporadic casesSporadic casesClusters of casesSyrian Arab RepublicYemenTerritories**occupied PalestinianterritoryRegion of the AmericasUnited States ofAmerica1120000000000000000600008122111

Saint Vincent and theGrenadinesNicaraguaSurinameTerritories**Puerto RicoMartiniqueGuadeloupeArubaBermudaFrench GuianaSint MaartenCayman IslandsUnited States VirginIslandsSaint MartinCuraçaoFalkland Islands(Malvinas)MontserratTurks and CaicosIslandsSaint BarthelemyBonaire, Sint Eustatiusand SabaBritish Virgin IslandsAnguillaSaint Pierre andMiquelonAfrican Region131010100021000Sporadic casesPendingSporadic 100000010Clusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of cases10300201543814010321000Clusters of casesSporadic casesSporadic cases10141211100000Clusters of casesSporadic cases09116001000Sporadic casesSporadic cases623543000010000Sporadic casesSporadic casesSporadic cases53191000Sporadic cases15South Africa3635170657AlgeriaCameroonGhanaCôte eaNiger76166273562202Burkina Faso60019380NigeriaSenegalDemocratic Republicof the missionClusters of casesClusters of casesClusters of casesCommunitytransmissionClusters of sters of casesClusters of casesCommunitytransmissionClusters of casesClusters of cases00200000301000

United Republic aTogoEquatorial GuineaZambiaCabo VerdeSierra EswatiniZimbabweAngolaMalawiBotswanaNamibiaCentral �o Tomé andPríncipeSouth SudanTerritories**RéunionMayotteSubtotal for allRegionsInternationalconveyance (DiamondPrincess)Grand 11010000142310000000001001000000010100Clusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesClusters of casesSporadic casesSporadic casesClusters of casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic casesSporadic 0000Sporadic casesSporadic casesSporadic casesSporadic casesSporadic cases111621274300000Sporadic casesSporadic cases0114103260150400Clusters of casesClusters of cases10254408073657

Coronavirus disease 2019 (COVID-19) Situation Report – 94 HIGHLIGHTS The Global Outbreak Alert and Response Network (GOARN) has launched a GOARN COVID-19 Knowledge hub. The hub is designed as a central repository of quality public health information, guidance, tools and webinars which can be accessed freely at any point.